Surgery Precautions for Myasthenia Gravis Patients

Understanding Myasthenia Gravis

Myasthenia gravis (MG) is an autoimmune condition that leads to muscle weakness and severe fatigue. It occurs when the immune system attacks and damages the connection between nerves and muscles. This prevents proper communication between the nervous system and muscles, making it difficult to control muscle movement.

Common Symptoms

Some of the most common symptoms of myasthenia gravis include:

• Drooping eyelids (ptosis)
• Double or blurred vision
• Difficulty swallowing (dysphagia)
• Slurred speech
• Weakness in the arms and legs
• Difficulty climbing stairs or walking long distances

Causes and Risk Factors

In most cases, the exact cause of myasthenia gravis is unknown. However, researchers believe it is caused by several factors:

• Genetics - MG sometimes runs in families
• Thymus gland abnormalities - The thymus helps produce immune cells, and abnormalities can trigger autoimmunity
• Autoimmune response - This damages acetylcholine receptors that allow communication between nerves and muscles

There are also risk factors that increase susceptibility to developing MG:

• Age - MG commonly affects women under 40 and men over 60
• Genetics and family history of MG
• Coexisting autoimmune disorders like lupus or rheumatoid arthritis
• Thyroid disorders like hyperthyroidism

Precautions for Myasthenia Gravis Patients Undergoing Surgery

When living with myasthenia gravis, extra precautions need to be taken for any surgical procedures to prevent complications from muscle weakness and sensitivity to medications.

Interactions with Anesthesia

The anesthesia drugs used during surgery can trigger dangerous side effects and complications in MG patients such as:

• Prolonged skeletal muscle paralysis
• Respiratory failure or breathing issues
• Exacerbations of muscle weakness
• Worsening MG symptoms post-surgery

There are some important precautions surrounding anesthesia and surgery with MG:

• Let the anesthesiologist know about your MG diagnosis so they can adjust the anesthesia and dosing
• An anesthesiologist experienced in working with MG patients should monitor you during surgery
• Plasma exchange before surgery may help remove harmful antibodies
• IVIG therapy can also help strengthen the immune system pre-surgery

Risk of Infection

MG patients have a weakened immune system, so infections pose a greater risk. Precautions include:

• Preventing respiratory infections with proper lung care before, during, and after surgery
• Following strict sterile protocols during the procedure
• Careful wound care and infection prevention post-surgery
• Watching for signs of infection like redness, swelling, oozing, fever, and reporting these immediately

Medication Management

Since MG patients require ongoing medication to manage symptoms, adjustments need to be made prior to surgery such as:

• Temporarily stopping medications like cholinesterase inhibitors before surgery under the guidance of the neurologist
• Planning for IV, tube feeding, or off-label administration if oral medications are restricted after surgery
• Monitoring symptoms for post-surgery exacerbation and adjusting medications to stabilize MG symptoms
• Following medication directions closely to help with optimal recovery

Slow Post-Op Recovery Period

Recovering from surgery tends to take longer for MG patients compared to the general population. Other post-operation precautions include:

• Planning for a longer stay in the post-anesthesia care unit for close monitoring
• Having a longer hospital stay to monitor for complications
• Allowing time for stabilized MG symptoms and strength to return to baseline before discharge
• Arranging post-hospitalization care services for longer recovery assistance at home

Available Treatment Options for MG

While there is currently no cure for myasthenia gravis itself, there are highly effective treatments available to manage symptoms and minimize complications like the ones surrounding surgery.

Medications

The main medications used include:

• Cholinesterase inhibitors - Increase communication between nerves and muscles
• Immunosuppressants - Suppress the overactive immune system attacking nerves
• Corticosteroids - Reduce immune activity and inflammation

Plasma Exchange Therapy

This procedure filters the blood to remove harmful autoantibodies attacking the nervous system. Improvement is often seen within a few weeks.

Intravenous Immunoglobulin (IVIG) Treatment

This involves infusing antibodies into the blood through an IV to regulate the immune system. The effects last several weeks.

Surgery

Some patients may benefit from surgery like:

• Thymectomy - Removes the thymus gland to prevent production of autoantibodies
• Medications implanted into the spinal cord - Pump out medication directly to the CNS for symptom control

However, surgery itself carries more risks with MG.

Living With Myasthenia Gravis

Myasthenia gravis is a chronic autoimmune disorder, but various treatments can control symptoms long-term. Implementing healthy lifestyle changes can also minimize symptom triggers.

With proper management and follow-up care from a team of knowledgeable doctors, most people living with MG can expect to enjoy remission with a close to normal quality of life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.